Severe Symptomatic Hyponatremia in Elderly Outpatients: The Role of Thiazide Therapy and Stress

Booker, John A.

doi:10.1111/j.1532-5415.1984.tb05849.x

Cited by 42 publications

(15 citation statements)

References 37 publications

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“…Five of the patients on thiazides resemble those described by Fichman et al (1971), Husby & Marthedal (1981 and Booker (1984), in whom hyponatraemia occurred within a short time of thiazide administration. Rechallenge by a single dose ofhydrochlorothiazide again caused a large fall in serum sodium in some patients (Fichman et al, 1971), and in one of our patients who was thus re-challenged, there was a reduction of serum sodium of 16 mmol/l within 24 hours.…”

Section: Methodsmentioning

confidence: 60%

“…A number of authors have suggested inappropriate ADH secretion as a cause for hyponatraemia induced by thiazides (Fichman et al, 1971;Horowitz et al, 1972;Luboshitzky et al, 1978;Husby & Marthedal, 1981;Booker, 1984). In the present investigation, fractional uric acid clearances were used to determine whether diuretic-induced hyponatraemia could be due to excess ADH activity or to other causes.…”

Section: Introductionmentioning

confidence: 90%

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Significance of the measurement of uric acid fractional clearance in diuretic induced hyponatraemia

Sonnenblick

Rosin

1986

Postgraduate Medical Journal

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Summary:The biochemical features of severe hyponatraemia due to thiazide administration in 7 nonoedematous patients were compared with those in hyponatraemia due to frusemide. Hypouricaemia has been shown to occur in hyponatraemia due to the syndrome of inappropriate antidiuretic hormone activity and this was measured along with fractional uric acid clearances in all the patients. Five of the patients had been on thiazides (or hydrochlorothiazide with amiloride) for only a few days to a few weeks. Fractional uric acid clearance was elevated and serum uric acid levels were low in five of them and returned to the normal range on restoration of serum sodium to normal. By contrast, the patients on frusemide did not show any abnormality in fractional uric acid clearance at any stage.These results are consistent with excess ADH activity as having caused hyponatraemia induced by thiazides in 5 of the 7 cases, whereas frusemide caused a sodium depletion syndrome. Treatment in the former cases is by water restriction, and in frusemide-induced salt depletion by saline supplementation.

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Section: Methodsmentioning

confidence: 60%

Section: Introductionmentioning

confidence: 90%

Significance of the measurement of uric acid fractional clearance in diuretic induced hyponatraemia

Sonnenblick

Rosin

1986

Postgraduate Medical Journal

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“…Although not structurally related to the catecholamines or cardiac glycosides, amrinone produces positive inotropic and vasodilatory effects, 1 increasing cardiac index and decreasing the pulmonary capillary wedge pressure without affecting arterial blood pressure or heart rate. 2 The mechanism of amrinone's positive inotropic activity, although not fully delineated, may be related to its ability to inhibit the phosphodiesterase III enzyme. 3 Amrinone is approved for intravenous administration.…”

Section: Extractomentioning

confidence: 99%

Severe Hyponatremia: An Association with Lisinopril?

Hume

Jack²,

Levinson³

1990

DICP

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A 63-year-old white woman with a history of hypertension and chronic obstructive pulmonary disease presented to the emergency room with worsening shortness of breath, anorexia, coughing, increased thirst, and leg edema of two weeks' duration. Medications included lisinopril 10 mg/d, which had been started six weeks earlier, sustained-release theophylline 300 mg q12h, and an albuterol inhaler. The lisinopril was discontinued on admission. Serum sodium concentration was 109 mmol/L; the osmolality of the blood and of the urine were 253 mOsmol and 438 mOsmol, respectively, with a specific gravity of 1.025 and a urine sodium of 17 mmol/L. The hyponatremia initially was considered to be the syndrome of inappropriate antidiuretic hormone secretion in response to the patient's suspected pneumonia. Due to worsening blood pressure, lisinopril was restarted and the serum sodium concentration dropped from 134 to 126 mmol/L. Evaluation of the patient's hyponatremia included assessment of thyroid, adrenal, hepatic, and cardiac function that were within normal limits. The patient was discharged on the following medications: sustained-release theophylline 300 mg tid, prednisone 10 mg/d, albuterol inhaler 2 puffs q6h, and sustained-release verapamil 240 mg/d for blood pressure control. Her serum sodium concentration has remained between 135 and 140 mmol/L during hospitalizations for exacerbations of chronic obstructive pulmonary disease and for pneumonias 10 and 12 months after discharge.

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“…Since that time, numerous additional cases have been reported, and diuretics are now recognized to be one of the most important causes of severe hyponatremia [2,3]. Yet, despite several relevant studies, the mechanism and optimal treatment of diuretic-induced hyponatremia remain unclear.…”

Section: Introductionmentioning

confidence: 99%

Diuretic-Induced Hyponatremia

Spital

1999

Am J Nephrol

119

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Diuretics are one of the most common causes of severe hyponatremia. Yet, despite several relevant studies and years of clinical experience, the mechanism and optimal treatment of diuretic-induced hyponatremia remain unclear. What is clear is that most cases are caused by thiazide rather than loop diuretics and that severe hyponatremia can develop very rapidly in susceptible patients. In this review, I will discuss the pathogenesis, clinical features, prevention, and treatment of diuretic-induced hyponatremia in the hope that increased awareness and understanding will reduce the incidence and complications of this potentially life-threatening syndrome.

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Severe Symptomatic Hyponatremia in Elderly Outpatients: The Role of Thiazide Therapy and Stress

Cited by 42 publications

References 37 publications

Significance of the measurement of uric acid fractional clearance in diuretic induced hyponatraemia

Significance of the measurement of uric acid fractional clearance in diuretic induced hyponatraemia

Severe Hyponatremia: An Association with Lisinopril?

Diuretic-Induced Hyponatremia

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